Intensive phacoemulsification training in Rwanda: Surgical outcomes of a structured training programme

While manual small-incision cataract surgery (MSICS) is widely practiced in sub-Saharan Africa (SSA), there is a regional unmet demand for phacoemulsification training. This study aimed to describe the implementation of an intensive phacoemulsification training program for MSICS surgeons in a high-volume cataract surgical centre at Kabgayi Eye Unit (KEU), Rwanda, and evaluate its outcomes. Retrospective audit of a structured educational intervention Two Rwandan ophthalmologists proficient in MSICS without prior phacoemulsification surgical experience The intensive phacoemulsification training program included a four-week ‘Foundational Training’ phase and a 12-month ‘Independent Practice’ phase. ‘Foundational training’ was delivered by an experienced visiting cataract surgeon from the United Kingdom and involved simulation, wet laboratory practice, video-based learning and supervised operating. During the 12-month ‘Independent Practice’ phase, trainees performed 2–3 cataract lists per week (6–8 cases per list) with on-site specialist phacoemulsification and vitreoretinal (VR) support available. Trainee competence was assessed in accordance with the Ophthalmology Surgical Competency Assessment Rubric (OSCAR). Outcome data was retrospectively collected for the training period and the 12 months of independent operating that followed. Both trainees met all competency milestones by the end of the four-week training period. During foundational training, 85 cases (mean age 68.1 years) were performed by both trainees, 21 (26.3%) requiring supervisor takeover. There were six cases (7.6%) with posterior capsule rupture (PCR), including one dropped intraocular lens (1.3%) managed by the on-site VR surgeon. During the Independent Practice phase, 754 cases (mean age 69.9 years) were performed by both trainees. There were 24 incidences of PCR (3.2%), including one dropped nucleus (0.13%) requiring VR intervention. Other complications included one case of endophthalmitis (0.13%) and one case of postoperative retinal detachment (0.13%). Pre- to postoperative improvement in Best Corrected Visual Acuity was 0.63 logMAR (p-value <0.001) during both training phases. This study suggests that intensive, competency-based phacoemulsification training for MSICS surgeons in SSA is feasible in units with sufficient resources and VR support. The speed at which phacoemulsification skills can be acquired through intensive training may make it a useful model for rapidly addressing training gaps in SSA.